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HomeMy WebLinkAboutMiscellaneous - 151 SANDRA LANE 4/30/2018 (2) 151 SANDRA LANE 210/097.0-0068-0000.0 M Commonwealth of Massachusetts Cit /Town of dI �� �j�^y l! "v� OVER System Pumping Record Facility Information: System Location: /, I Address �) City/Town State Zip Code System Owner: Name: Adress (if different from location of pump) City/Town State Zip Code -4!;-g -i�o ­7 Telephone Number Pumping Record Date of Pumping Quantity Pumped gallons Type of System__X Septic Tank Grease Trap Other (what) System Pumped by: \m' Lc.6'u Company: ROOTER-MAN 46 Portland Street Lawrence, MA 01843 Location where contents were disposed:--JL,( ,LO Signature of Hauler Date RECEIVED COmmonwealth of Massachusetts MAY 12 2009 C Ity/Town of No ( 1TOWN OF NORTH ANDOVER ��ov System PUmping Record HEALTH DEPARTMENT Facility Information: System Location: 151 bra e, Address y/Town d W2 State Zip Code System Owner- Name: A,dress (if different from location of pump) City/Town State Zip Code U 7 Telephone Number Pumping Record Date of Pumping Quantity Pumped ��� gallons Type of System Septic Tank Grease Trap other (what) System Pumped by: _ ve, horn pany* ROOTER-MAN 12 East Dracut Rd., Methuen, MA 01844 Location where content ere disposed: Signature of Hauler I (� Date Commonwealth of Massachusetts CitylTown of Iv .. A71L ' 6L4 6L System PumpingRecor Form 4 DEP has provided this form for use by local oards of Health. Other forms may ed, ut the information must be substantially the same s that provided here. Before sing t�orm, h��v�ith your local Board of Health to determine therm they use.The System Pumpi g Record must be submitted to the local Board of Health or other appro in authority. T� "�' /ER A. Facility Information Important: When filling out 1. System Location: forms on the YA - to computer,useonly the tab key move your 416 0-e^ _ cursor-do not ity/Town , StMe Zip Code use the return key_ 2. System Owner- VG Name € �A� Address(d different from location) Citylrown State Zip Code Telephone Number B. Pumping Record -7\ 1. Date of Pumping Itae 2. Quantity Pumped: Gallons v V 3. Type of system: ❑ Cesspool(s) 74 ptic Tank ElTight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes toe- If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: d d 6. System Pumped By: (�C' J 1-) N Vehicle license Number C mpany 7. Location where contents were disposed: Si ature f Hauler Date t5form4.dov 06103 System Pumping Record•Page 1 of 1 i TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: 1 0 4 QUANTITY PUMPED 00 GALLONS I I CESSPOOL: NO YES SEPTIC TANK: NO YES I i NATURE OF SERVICE: ROUTINE v EMERGENCY .OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: r' MASSACHUSETTS UNIFORM APPC,ICATION FOR PERMIT TO DO GASFITTI.NG t (Print or Type) NORTH ANDOVER Mass. Date / / r b �uilding Location/,�-( C/)--yd4 - 1?y Permit I# 'Zd o Owners Name • Y . . New ''Renovation II Replacement Plans Submitted D c FI X 7 U P as YW N z tr as W us 0 us tJf W d Q OP- t F2d a H G1d' G W N0 } C4s Q W W W W < t7 h i.. F' 2 t. W W Qu O} W W tt: O O = u_ O C1 .s U C` �• G a h- O SUa-3STMT. I I I i t I I BASF-MEXT IST FLOOR I I I ( I I I M I I I I I I 2ND FLOOR ( I I I ( ( I I I I I I I I 3RD FLOOR 4TH FLOOR I I I I I I ( I I I I I I STH FLOOR ( I ( II I I I I I I 6TH FLOOR t I I 7TH FLOOR I I I I I I f TH Q FLOR 8I I (Print or Type) ` Check one: Certificate Installing Company Name _ -f /ei� rya -e Corp. Address S U Voy ro rz S�'��:,T Partner. /Wv cly,esZ. C-Z"- Firm/Co. Business Telephone: L:2�� 6- 'T Z 0 Name of Licensed Plumber or Gas Fitter Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy EET--Other type or indemnity Q Bond Insurance Waiver: I , the undersicned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner 17 Agent Q I hereby ecrtify that all of the details and informatiort I have submitted (or entered)in above appfieation are true and arcuate to the best of my knowicdge and drat at! plumbing work and Instattations perforated under*Persait issued for this app8ation will be in complianea with ad pertincat provisions of the Massachusetts State Cas Code and 447tes 142-cf ase C—cral Laws. By TYPE LICENSE: lumber Title Gasfitter Signa ure of Licensed City/Town- aster Plumber or Gasfitter Journeyman (7-0 3 6 - APPROVED (OFFICE USE ONLY) L.Lcen&e slumber C� Ir TOWN OFAANDOVER SEPTIC SYSTEM SERVICING REPORT Date:. Homeowner: c5e _ Pumper Street : SSI Address: ( � Phone �o�'Cl o�Dcit'� Phone Nature of Service: Routine Emergency Observations: Good Condition Full to Cover Baffles in Place Leachfield Runback Excessive Solids Heavy Grease Roots Other (Explain) i i Description of rk P — — — --- ----_ Comments : lD�� A��pnfS' if rnnn ..d � WATERSHED RESIDENTS QUESTIONNAIRE 1. Name ald, 2. Street Address C 3. How many members are in your household? 4. What type of sewage disposal system do you have? ❑ cesspool ❑ septic tank and leaching area © connection to municipal sewer ❑ other (describe) ❑ do not know 5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? V] yes ❑ no ❑ do not know 6. How old is your sewage disposal system? ❑ 0-5 years KI 6-10 years ❑ 11-20 years ❑ over 20 years ❑ do not know 7. Has your sewage disposal system been rebuilt or repaired? ❑ yes E no ❑ do not know If yes, approximately how long ago? years. What was done? 8. How frequently is your sewage disposal system pumped out? annually O ❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never 9. Have you had any problems with your sewage disposal system? ❑ yes no If yes, what problems? ❑ repeated pump-outs needed ❑ system clogs, backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10. How many of each appliance are connected to your sewage disposal system? washing machine dishwasher garbage disposal dehumidifier drain sump pump toilet roof/pavement drains shower/bathtub _ 11. Please state the brand and type (liquid or powder) of detergent you use for: dishwasher clotheswasher 12. Does your property have a lawn? yes ❑ no If yes, approximately what size? ❑ less than 1/4 acre ❑ 1/4 acre ® 1/2 acre ❑ 3/4 acre ❑ 1 acre ❑ more than 1 acre (Specify) acres 13. How often do you fertilize your lawn? : �f No. of applications per year Season(s) of the year 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: 2 Check here if your lawn is maintained by a professional landscape contractor. QUESTIONNAIRE 2. Streit Address 3. Ho-vN meily members are in your household? 4. Q'Jh t type of sewage disposal system do you have? ❑ cesspool :;rptic tank and leaching area El connection to municipal sewer ❑ other (caescribe) ❑ CEJ nol know E 8 5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? � DFI dies ❑ no ❑ do not know 3 6. 1:�ovH old is your sewage disposal system? ❑ 0-5 years R1 6-10 years ❑ '11-20 years over 20 years ❑ do not know 7. Has your sewage disposal system been rebuilt or repaired? ❑ ves N no ❑ do not know 1 f yes, approximately how long ago? years. What was done? v 8. Jicr..'I• frequently is your sewage disposal system pumped out? ® annually ❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never 9. ave you had any problems with your sewage disposal system? ❑ yes E) no yes, what problems? ❑ repeated pump-outs needed ❑ system clogs, backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10. 1 ovt many of each appliance are connected to your sewage disposal system? -gashing machine 1 dishwasher garbage disposal c:ehumidifier strain �_ sump pump toilek� roc£!pavement drains showerlbathtub _ 11. Please state the brand and type (liquid or powder) of detergent you use for: C-i —1 washer hiiiyl��r C.©�CG?L�k clorr:eswasher /✓� 12. Does your property have a lawn? 9 yes ❑ no if yes, approximately what size? ❑ less than 1/4 acre ❑ 1/4 acre ® 1/2 acre ❑ 3/4 acre ❑ 1 acre ❑ more than 1 acre (Specify) acres 13. 110-r•- often do you fertilize your lawn? of applications per year of the year C; 7f-- l� ?� 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: r isl Check here if your lawn is maintained by a professional landscape contractor. f TOWN OFAANDOVER SEPTIC SYSTEM SERVICING JUN � 6 REPORT Date: 1��"i -- ----- ---- - -- -------- --, - �+ _ � ` Homeowner:— �)i�� Pumper Street _ X51 ��aQAddress: Phone —�po _ Phone i Nature of S 1'_r vice: Routine Emergency Observations: . Good Condition Full to Cover Baffles in Place Leachfield Runback Excessive Solids Heavy Grease Roots Other (Explain) Descript__on of Work; Comments : lvo',-A�N TOWN OFA ANDOVER SEPTIC SYSTEM SERVICING REPORT Date: V� Homeowner:_�2y ��_ Pumper : R.04er, Street :1`51 �'r ,ac� r�_ Address: 13- Phone 3Phone (0 ��' �D�10 Phone Nature of S-:rvice: Routine Emergency Observations: Good Condition / Full to Cover Baffles in Place Leachfield Runback Excessive Solids Heavy Grease Roots Other (Explain) Description of Work: t�°� 606 — Comments : 10 Commonwealth of Massachusetts RECOVED City/gown of P6 Y+A pv&Ue JUL 14 Z-010 System Pumping Record TOHEA 1H EPARTMENT R Facility Information: System Location: sJa/�dra Loa-p Address Mpq City/Town State Zip Code System Owner: u r .SOS Name: Adress (if different from location of pump) City/Town State Zip Code q78 -a5D- 176 7 Telephone Number Pumping Record Date of Pumping 1 '1 11 U Quantity Pumped / Jy gallons Type of SystemK--Septic Tank Grease Trap Other (what) System Pumped by: q Ue I 1 4 Company: ROOTER-MAN 12 East Dracut Rd., Methuen, MA 01844 Location where contents were disposed: Signature of Hauler (/f Date l ` LJ Commonwealth of Massachu efts RECEIV . City/Town ofNhJN 212010 System Pumping ecordTOWN OF NORTH ANDOVER HEALTH DEPARTMENT Facility Information: System Location: ay Address v �l S City/Town State Zip Code System Owner: Name: Adress (if different from location of pump) City/Town State Zip Code 910 , 76 Telephone Number Pumping Record . Date of Pumping t4d Uq ��((// �� �anti ty Pumped_... (/V gallons Type of System 4Septic Tank Grease Trap Other what System Pumped by: U (� Company: ROOTER-MAN 12 East Dracut Rd., M(huen, MA 01844 Location where con is were disposed: ' Signature of Hauler Date I� r LRECEIVED CO onwealth. of Massachus9 2011 D 1 City/Town Of �jAYJw �, System Pumping Record Facility Information: System Location- Address it<1Town State Zip Code System Owner: `-Tyy- Name: .dress (if different from location of pu�npj C; r3!To n State Zip fode Telephone Number Pumping Record Date of Pumping �'f (P �/ Quantity Pumped /SU1�1 gallons Type of System_�Septic Tank Grease 'Trap Other (what) System Pumped by: I. 1e Company- ROOTEIR-MAN 46 Portland Street Lawrence, IA 01843 Location where contents were disposed: /2$ Signature of Hauler r f Date l�